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Do IgA, IgE, and IgG avidity tests have any value in the diagnosis of toxoplasma infection in pregnancy?
AIM: To determine the value of tests for specific IgA, IgE, and IgG avidity in diagnosing Toxoplasma gondii infection during pregnancy. METHODS: In a retrospective study, current serological tests (dye test and three IgM assays with different sensitivities) were compared with immunosorbent agglutination assays (ISAGA) for specific IgA and IgE and an IgG avidity enzyme linked immunosorbent assay (ELISA). Patient group 1 comprised six women with definite or probable infection during pregnancy determined by congenital toxoplasmosis or laboratory results. Group 2 comprised seven women infected during or before 11 pregnancies (two consecutive pregnancies in two patients and three in a third). RESULTS: One patient in group 1 seroconverted during pregnancy. IgA ISAGA and avidity confirmed acute infection when confirmatory IgM ELISA remained negative. In five of six patients from group 1, IgA and IgE ISAGA and avidity confirmed acute infection. In group 2, the dye test titre was raised in seven of 11 pregnancies (six of seven patients). Specific IgM and IgA were positive during all 11 pregnancies. IgE ISAGA was positive in only four of 11 pregnancies (three of seven patients), but negative results in the remainder may exclude acute infection. High avidity antibodies indicative of past infection were found in four of 11 pregnancies (two of seven patients). CONCLUSIONS: Each test improved diagnosis or timing of infection but no single test was ideal. The IgA ISAGA was sensitive and detected seroconversion. Positive IgE ISAGA and low avidity both confirmed infection, whereas negative IgE may exclude acute infection. High avidity diagnosed past infection but persistence of low avidity reduced its value to differentiate acute and past infection. Further studies with larger patient groups are needed to determine the optimum diagnostic strategy. These techniques are valuable in complementing existing tests.
Perinatal encephalopathies caused by maternal diseases during pregnancy.
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Cutaneous manifestations of toxoplasmosis.
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Congenital skin defects, twins and toxoplasmosis.
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Seroprevalence of Toxoplasma gondii in wild toque macaques (Macaca sinica) at Polonnaruwa, Sri Lanka.
From a natural population that inhabits the dry evergreen forest at Polonnaruwa, serum samples of 170 toque macaques were examined for antibodies to Toxoplasma gondii by the modified agglutination test. Of these, 21 (12%) were found with titers of 1:16 in 9, 1:32 in 9, 1:256 in 1, 1:1,024 in 1, and 1:4,096 in 1. There was no evidence of maternal transmission of antibodies or congenital toxoplasmosis. None of the infected macaques died within 1 yr after sampling. Toxoplasma gondii infection was closely linked to human environments where domestic cats were common. Macaques having frequent contact with human settlements showed a significantly greater (P < 0.0001) prevalence (19% infected) than macaques restricted to forest habitat, none of which was infected. Although infection with T. gondii has been noted in several species of Asian primates, this is the first report of T. gondii antibodies in toque macaques (Macaca sinica) that are endemic to the island of Sri Lanka.
Epidemiological aspects of Toxoplasma infections among women in Norway.
In order to elucidate some of the epidemiological factors involved in the acquisition of Toxoplasma infections in Norway, 196 women were requested to answer a series of questions in their post-natal periods. Of these women, 27 had recently been infected with T. gondii, 84 had old infections, and 85 were non-infected. The answers given indicated that frequent intake of raw meat and frequent travelling abroad, especially to countries with high infection risks, were of great significance for the contamination among adults. Living in rural districts appeared to represent a predisposing factor for the acquisition at younger ages. Contacts with animals, especially cats, were not shown to increase the infection risk. With special reference to the results obtained, a list of instructions to sero-negative pregnant women is proposed in order to prevent congenital toxoplasmosis in the Scandinavian countries.
Prenatal serologic screening in Bahrain.
Between 1988 and 1990, serological surveys designed to study local disease prevalence and assess the clinical value of various prenatal screening tests were undertaken at Salmaniya Medical Center in Bahrain. High maternal antibody prevalence (greater than 85%) to cytomegalovirus (CMV), herpes simplex virus (HSV) and rubella was demonstrated, and 28% showed antibodies to Toxoplasma gondii. The lowest seroprevalence values were found for HBsAg (1.2%) and Treponema pallidum (0.9%). Routine testing for rubella, syphilis, and hepatitis B are advocated for all pregnancies in Bahrain. In contrast, CMV and HSV serologies are not recommended. Toxoplasma antibody testing remains controversial, but the lack of a proven agent to prevent congenital toxoplasmosis coupled with the high cost of serial testing mitigates against its routine use at this time.
Hydrocephalus combined with congenital cataract and microphthalmia.
We describe a case of bilateral microphthalmia with bilateral congenital cataracts associated with hydrocephalus in a 9-month-old girl with consanguineous parents. The differential diagnosis included: (1) congenital rubella syndrome; (2) congenital toxoplasmosis; (3) chromosome alterations; and (4) metabolic disease. However, negative clinical, laboratory, and instrumental investigations excluded all of these hypotheses. We stress the usefulness of echography in establishing whether or not infection has occurred during intrauterine life.
Cell culture isolation of Toxoplasma gondii from an infant with unusual ocular features.
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Congenital choroido-retinitis and cerebral damage from unidentified infective agents.
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[Diaphragm pacing in chronic hypoventilation].
BACKGROUND: Diaphragm pacing in patients with intact phrenic nerve and diaphragm can be used as an alternative to mechanical ventilation. Indications cover diseases caused by central hypoventilation like C2-quadriplegia and Ondine's syndrome. Advantages are physiological ventilation with negative pressure and an improvement in articulation. CASE REPORT: We report our experiences with a patient suffering from chronic hypoventilation caused by a ventilatory pump failure following tetraparesis due to congenital toxoplasmosis.
Immunoglobulin classes of antibodies produced against Toxoplasma gondii by ovine fetuses.
Sera from aborted or newborn lambs with congenital toxoplasmosis were fractionated on Sephadex G-200. Sera and fractions were tested for Toxoplasma antibodies using the indirect fluorescent antibody test. Most of the antibody was found to reside in the IgG fraction.
[TORCH complex].
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[Risk assessment of vertical transmission of Toxoplasma infections].
BACKGROUND: It is important to estimate the risk of congenital toxoplasmosis infection and its clinical sequelae. This information will assist the clinical counselling of pregnant women with acute toxoplasmosis and may guide individual decisions on investigative and therapeutic options. METHODS AND PATIENTS: Since January 1998 to July 2000 we collected data on 63 pregnant women referred to our Prenatal Diagnosis Centre for suspicion of acute maternal toxoplasmosis. In case of positive screening tests for IgG and IgM or documented seroconversion, we sent samples of maternal serum to a reference laboratory to detect specific IgM, IgG, IgA antibodies and IgG avidity. We estimated the risk of mother-to-child transmission as high or low in relation to gestational age at the time of maternal seroconversion. Antiparasitic treatment with spiramycin since before confirmation of infection and evaluation of fetal biometry were done. In high risk women we advised amniocentesis for polymerase chain reaction (PCR). If infection was diagnosed in the fetus, the regimen of treatment was changed. Live-born children of all these mothers were followed up serologically for at least 1 year. RESULTS: In 13/63 cases (20%) we excluded maternal infection. Thirty-six out of 63 cases (57%) with high transmission risk underwent an amniocentesis, except one case requesting termination of pregnancy. Four out of the remaining 14 cases estimated at low risk had an amniocentesis for maternal anxiety. Among high risk women, PCR on amniotic fluid was positive in 4 cases (10%): 2 of these requested pregnancy termination, while the other 2 decided to proceed with the pregnancy and the therapy was shifted to 3 weeks courses of pyrimethamine and sulphadiazine with folinic acid alternating with spiramycin. Five infants were lost at follow-up, 20 babies resulted not infected and the remaining 21 are still followed-up. CONCLUSION: It is possible to select by specific serological tests, high risk cases for mother-to-child transmission of infection and to decide a specific approach.
[The IgM test in infectious pathology of newborn and other infants].
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